Appendix 1 Study Protocol Ca
Appendix 1 Judith Lumley Centre for mother, infant and family health research College of Science, Health and Engineering La Trobe University Maternal health research in a tertiary health care facility in Lima, Peru Structured questionnaire for face to face interview Code number: __ __ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Interview Date: ___ ___ / ___ ___ /___ ___ ___ ___ D D M M Y Y Y Y Thank you for agreeing to participate in this study. You are free to not answer any questions. If any of the questions are unclear, or you need more information the interviewer will be happy to provide you with the information you need. Before I start, do you have any questions? SECTION A. GENERAL INFORMATION WOMAN INFORMATION First I would like to ask you some questions about your background. A1.How old are you? __________ (Years) A2. Place of residence 1. Lima Norte (Ancón, Carabayllo, Comas, Independencia, Los Olivos, Puente Piedra, San Juan de Lurigancho, San Martin de Porres, Santa Rosa) 2. Lima Este (Ate, Cieneguilla, Chaclacayo, El Agustino, Lurigancho, San Luis, Santa Anita) 3. Lima Sur (Chorrillos, Lurín, Pachacamac, Pucusana, Punta Hermosa, Punta Negra, San Bartolo, San Juan de Miraflores, Santa María del Mar, Villa el Salvador, Villa María del Triunfo) 4. Residential Lima (Barranco, Jesús María, La Molina, Lince, Magdalena, Miraflores, Pueblo Libre, San Borja, San Isidro, San Miguel, Santiago de Surco, Surquillo) 5. Callao (Bellavista, Callao District, Carmen de la Legua Reynoso, La Perla, La Punta, Ventanilla District) 6. Central Lima (Breña, La Victoria, Downtown Lima, Rimac) A3.
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